Gilda Ibacache S

Estudio bacteriológico de la bilis vesicular en un área de alto riesgo de cáncer vesicular

BACKGROUND: Gallbladder cancer is frequent in Chile and there is sparse information about the association between this type of cancer and the presence of bacteria in the gallbladder bile. AIM: To determine the presence of aerobic bacteria in gallbladder bile in patients with and without gallbladder cancer. MATERIAL AND METHODS: A microbiological analysis of bile and pathological study was performed in 608 gallbladders, obtained during to cholecystectomies performed to 513 women and 95 men aged 44 years old as a mean. RESULTS: Pathological study showed a chronic cholecystitis in 468 cases (77%), an acute cholecystitis in 140 (33%), cancer in 24 (3.9%) and dysplasia in 5 cases (0.8%). A positive culture was obtained in 22.5% of women and 28.5% of males. Twenty seven percent of women over 30 years old had positive cultures compared with 10% of younger women (p < 0.001). Thirty two percent of acute cholecystitis had positive cultures, compared with 24% of chronic cholecystitis (p = 0.03). E Coli was isolated in 51% of positive cases, Streptococci-Enterococci in 24%, Enterobacter sp in 9%, Klebsiella and Proteus in lower proportions. Salmonella sp was isolated in 4 cases, being all women with chronic cholecystitis. Thirteen of 29 cases with cancer or dysplasia had positive cultures (45%), compared with 25% of patients with inflammatory gallbladder diseases (p = 0.02). Streptococci-Enterococci were isolated in 7 cases and Enterobacter sp in three. CONCLUSIONS: The presence of Salmonella sp in gallbladder bile was not frequent in the studied patients. Its role in the pathogenesis of gallbladder cancer must be reassessed.

Desde la displasia hasta el cáncer de la vesícula biliar

Background: There is scarcity of knowledge about the development of gallbladder cancer. Aim: To study the features of development and progression of gallbladder cancer. Material and methods: Review of histopathological studies of gallbladder obtained in 25,971 cholecytectomies performed in patients aged 45± 16 years, 79% females, between 1993 and 2004. Among these, 210 had a dysplasia not associated to cancer and 1,039 had a gallbladder cancer Clinical and morphological parameters of preneoplastic and neoplastic lesions were analyzed. Ninety five percent of patients were followed. Results: All cases of dysplasia were incidental findings. Metaplasia, dysplasia and carcinoma in situ were present in the adjacent mucosa in 66%, 81% y 69% of gallbladder carcinomas, respectively. Twenty five percent of gallbladders studied were carcinomas (mucous carcinoma in 18% and muscular carcinoma in 7%). Ninety two percent of cases had chronic inflammation in the gallbladder wall. Seventy two percent of mucous carcinomas were not detected macroscopically Five years survival of mucous carcinoma was 92%. There was an association between the intensity of the lesion and the age of the patients. The age difference between chronic cholecystitis and gallbladder cancer was 11 years for women and nine for men. Conclusions: From a morphological standpoint, the period in which a dysplasia becomes a carcinoma is approximately 10years.

Inactivación del gen CDKN2A (p16) en cáncer de la vesícula biliar

: We analyzed themethylation status of the promoter region of the CDKN2A gene in gallbladder adenocarcinomasusing methylation specific PCR (MSP). We also used microsatellite markers near the CDKN2Agene to detect allelic imbalance (AI) and examined the tumors by immunohistochemistry (IHC)for p16 expression.

Expresión de CD44 (HCAM) en el carcinoma subseroso de la vesícula biliar

BACKGROUND HCAM or CD44 is a multifunctional cell adhesion molecule, related to cell-cell, cell-extracellular matrix interactions and involved in tumor invasion. AIM To study the importance of CD44 expression in subserous gallbladder carcinoma. MATERIAL AND METHODS One hundred five samples (93 female) of subserous gallbladder carcinoma and 33 non tumoral gallbladder were studied. CD44 was stained using the streptavidine-biotin technique, using human anti CD44 antibodies. Eighty subjects with carcinoma were followed for a period up to 105 months. RESULTS Mean age of patients was 62.6 years old, all tumors were adenocarcinoma, all were silent and 13% were well differentiated. CD44 was expressed in all controls and in 91%, the expression was normal. In 57% of cancer samples, CD44 expression was abnormal, in 50% it was less expressed and in 24%, it was not expressed. No differences in CD44 expression was observed between mucosa from control samples and mucosa adjacent to the tumor or superficial or deep tumoral areas. Global five years survival was 40%. No significant differences in survival were observed in those tumors with a lower of absent CD44 expression. Six patients with a higher expression died before 18 months of follow up. CONCLUSIONS Nearly 50% of subserous gallbladder carcinomas show an abnormal CD44 expression.

Carcinoma subseroso de la vesícula biliar: expresión del complejo caderina-catenina

Background: Subserous gallbladder carcinoma is difficult to diagnose and treat. There are no tissue markers with prognostic value in this type of tumor. Aim: To study the immunohistochemical expression of E-cadherin alpha and beta catenin in subserous gallbladder carcinoma. Patients and methods: One hundred seventeen subjects (103 women and 14 men aged 62 and 69 years as a mean, respectively), were studied. Thirty five gallbladder samples without evidence of cancer were used as controls. Expression of markers was studied with standard immunohistochemical techniques for formalin fixed and paraffin embedded tissue. Results: Ninety seven percent of tumors were adenocarcinoma. A lower or absent expression of E-cadherin, alpha catenin and beta catenin was observed in 26, 33 and 29% of tumors, respectively. Actuarial five years survival was 37%. No association between macroscopic features of the tumor and survival was observed. Well differentiated tumors had a 73% survival, whereas less differentiated tumors had a 30% survival. Tumors with a normal expression of the markers had a slightly better survival, although not significant (p=0.06). Conclusions: Approximately 30% of subserous gallbladder carcinoma have an abnormal expression of E-cadherin, alpha catenin and beta catenin. This abnormal expression has no relationship with prognosis and is probably secondary to the aberrant genic expression of the tumor (Rev Med Chile 2002; 130: 1349-57)

Colesterolosis y cáncer de la vesícula biliar

Background: Cholesterolosis is frequently observed in cholecystectomies performed for lithiasis or chronic cholecystitis. Aim: To determine the degree of association between cholesterolosis and gallbladder cancer. Material and Methods: In a prospective study of gallbladder cancer, all gallbladders obtained during cholecystectomies were processed for pathological study, following a special protocol. As part of this study, 23304 surgical samples obtained between 1993 and 2002 were studied, looking for a relationship between cholesterolosis and chronic cholecystitis, adenomas, dysplasia and gallbladder cancer. Results: Seventy nine percent of patients were women. Cholesterolosis was observed in 3,123 cases (13.4%). Cholesterolosis was more common in women (14.2%) than in men (10.2%) (p < 0.001). In the same period, 29 patients were diagnosed with adenomas (0.12%), 179 cases with dysplasia not associated with gallbladder cancer (0.8%) and 739 gallbladder cancer (3.2%). The frequency of cholesterolosis was 13.8% in chronic cholecystitis, 13.7% in adenomas, 12.1% in dysplasias and 1.35% in patients with gallbladder cancer (p < 0.01). Of the thirteen cases with gallbladder cancer and cholesterolosis, 10 were early gallbladder carcinomas. Patients with cholesterolosis were 9.2 times less likely to have cancer than those who did not have cholesterolosis. Conclusions: Cholesterolosis has a strong negative association with gallbladder cancer.

Proliferación celular en la mucosa de la vesícula biliar no tumoral en colecistitis crónicas litiásicas. Expresión de Ki-67 en matrices de tejidos

29% (range 3%-98%) in gallbladdercancer (p <0.01). Ki-67 was expressed in less than 10% of epitelial cells in 55% of non tumoralmucosa samples and 6% of gallbladder cancer samples. Seventy five percent of gallbladder cancersamples had a staining index of more than 20%. An expression of Ki-67 over 20% or 50% wasobserved in 25% and 15% of non tumoral mucosa samples, respectively.

Inestabilidad microsatelital en lesiones preneoplásicas y neoplásicas del cuello uterino: Correlación con el genotipo del virus papiloma humano

Biopsy samples of cervical lesions were studied. Sixteen hadlow grade lesions, 22 had high grade lesions and 28 had an epidermoid cancer. Viral types wereidentified with polymerase chain reaction, dot-blot hybridization and restriction fragment lengthpolymorphism. MSI was determined using a panel of eight highly informative microsatellites.

Carcinoma subseroso de la vesícula biliar (pT2): Valor pronóstico de la expresión de los genes supresores de tumores p53 y p27 en matrices de tejidos

Thirty eight percent oftumors were not detected at the macroscopic examination, 52% and 17% had lymph node and bloodvessel involvement, respectively. Fifty six and 46% were positive for p53 and p27, respectively. Noassociation between the expression of both genes and gender, degree of differentiation, lymph node orblood vessel involvement, was observed. Overall five years actuarial survival was 32%. Patients withpositive or negative p53 expression had a 22% and 53% survival, respectively (p =0.05). No associationbetween survival and p27 expression was observed.